Features

Nursing at the Los Angeles Metropolitan Jail

When the Patient Is in Handcuffs

Thanksgiving is always a hectic time for the Los Angeles Police Department’s Jail Division and this weekend was no exception. As nurse Annette Olvera, RN, began to examine one blood-covered arrestee, he leaned in and asked in a whisper, “Do you think my wife’s family is going to come after me? I stabbed her 27 times.”

Although alarming statements like these are not uncommon in Olvera’s work, she says her job is not dangerous. “Two LAPD officers stay with each patient, so I always feel safe,” she says. “Working in a hospital emergency department is far worse.”

AN ARRESTING EXPERIENCE

Olvera knows from experience, having begun her career as an ER nurse. She then took a job at Disneyland, where she worked in the guest services department treating twisted ankles, sunburns and sudden illnesses of park visitors. Eight years ago, her career path took a sharp turn when she was recruited to corrections healthcare, a job she has found very satisfying. “The nursing here feels more real,” she says. “I love the autonomy we have.”

When someone is arrested within the City of Los Angeles, he or she is taken to the Metropolitan Jail at 180 N. Los Angeles Street for processing and booking. One step of that process is for the arrestee to be evaluated by the jail’s medical team, which includes Olvera and her colleagues.

Jail Division nurses are bound by the same confidentiality rules as any other healthcare provider. Their job is not to gather evidence or judge an arrestee’s guilt, but to provide medical care while a person is in custody. Due to HIPAA restrictions, only one arrestee can be evaluated at a time, although LAPD officers are always present.

Every step of the booking process is timed: It takes an average of 10 to 12 minutes to complete each medical screening. The goal is to process arrestees as quickly as possible to allow police officers to resume their normal patrols. “We can’t catch more bad guys from inside the jail,” says one officer.

After the initial evaluation, arrestees are seen as needed during their stays at the jail, which usually lasts less than 72 hours from arrest to arraignment. Nurses make rounds of the jail cells every four hours, although patients who are under the influence of drugs or alcohol are observed more closely as they detox. “Heroin is the worst,” Olvera says. “Those patients are the sickest.”

Photo, top of page: Annette Olvera, RN, with LAPD officers, Sgt. Valle, Sgt. Kim and Sgt. Angelo. Olvera worked at Disneyland before coming to the Jail Division; above: Joanna Escobar, RN, who joined the Medical Services Bureau as a new grad.

AS SEEN ON TV

Walking through the jail is fascinating for any diehard fan of TV shows like “Law and Order.” Past the booking area, where mug shots and fingerprints are taken, there are interview rooms, padded cells for Section 5150 psychiatric holds and the actual jail cells and general population bunk rooms.

The jail’s busiest times are holidays and days on which the LAPD is doing a task force sweep. Although typically about 90 percent of arrestees are male, the female side of the jail may be full if the LAPD is doing a prostitution sweep. Transgender inmates are held separately for their safety.

The Jail Division’s commanding officer, Capt. David Lindsay, says a facility like this one averages 26 suicides per 100,000 arrests, but last year, his jail had only one, just a fraction of the national average. He attributes the low death rate to the excellent care provided by the medical services team.

ADVENTURES IN NURSING

Nursing in an urban jail setting is not for everyone. “It’s hard to talk to my family about my day,” says Joanna Escobar, RN, who was hired by the jail right out of nursing school and mentored by Olvera.

“You definitely need a thick skin to work here,” says Jail Division nurse practitioner Frank Torres, MSN, FNP-C, “because you get called every name in the book.”

The nurses have learned not to take such comments or outbursts personally. Arrestees are often angry or in pain and don’t always understand that the medical team is there to help them. Rudeness and boundary issues are frequent and thank yous are rare.

Nevertheless, Olvera, Escobar and Torres love the challenge and adventure of the work. Jail Division nurses work autonomously and must make swift decisions based on little information. Since there is usually no medical chart or prescription history and patients often withhold facts about substance use and sexual activity, the nurse’s job involves a lot of detective work.

Fortunately, the nurses have a strong bond with each other and the LAPD officers with whom they work. “I decompress by calling Annette after work,” says Escobar. Team members are united by their common experience and their mutual commitment to providing their arrestee patients with the best possible care.